Spasticity or restless legs syndrome?
Ms Elsa MAURUCa, Dr Maria Antonia QUERA-SALVAa, Dr Angélique BROTIERa, Dr Caroline HUGERONa, Dr Célia RECHa, Prof Djamel BENSMAILa
a Service de MPR, Unité blessés médullaires, Hôpital Raymond Poincaré,AP-HP, Université de Versailles Saint Quentin.
Introduction: The Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by an urgent need to move the limbs (typically the legs), associated with unpleasant feelings, sometimes painful, in the evening or early night. Periodic leg movements (PLM) may occur during sleep. These are characterized by an extension movement of the hallux, dorsiflexion of the ankle and sometimes knee flexion and hip. The pathophysiology of RLS is not fully understood.
Studies have shown an increased prevalence of RLS in patients with Spinal cord Injury (SCI) or Multiple Sclerosis (MS).
Objective: the diagnosis of spasticity or RLS in patients complaining of repeated nocturnal spasms in patients initially seen in consultation because of spasticity resisting to pharmacological treatment.
Method: Prospective study, from March 2014 to March 2015, monocentric, in the MPR Service Hospital Raymond Poincaré. Inclusion criteria: age over 18 years, SCI, MS patients, with nocturnal predominance spasms. Exclusion criteria: presence of pressure sores, unable to achieve a polysomnogram.
Weekday hospital patients for predominantly nocturnal spasms resistant to pharmacological treatment of spasticity orally or even to intrathecal therapy (IT) IT baclofen, associated with sleep disorders, underwent a polysomnography. If RLS exists, 0.18 mg of pramipexole was administered to the patient, followed by a control polysomnography.
Results: Eleven patients (5 MS, 5 SCI and a patient with hereditary spastic paraplegia) were included. All had polysomnography for RLS. A significant improvement was experienced on 10 patients, with a important reduction PLM on polysomnography control, after administration of pramipexole.
Discussion: This pilot study shows that RLS may be a differential diagnosis of spasticity. The presence of nocturnal or supine position spasms, in patients with central nervous system lesions of SCI or MS types must result in the research for RLS and test the effect of dopamine agonists in the case of positive diagnosis.
Keywords : restless legs syndrome, spasticity, multiple sclérosis,spinal cord injury, dopamin agonist